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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ^ Q--UD-an00 Permit Number: JrDLmsa-
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A ✓ :
Building Permit Application o
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1S78 Commercial Residential
PERMIT TYPE: Building Permit / POOI
PROPOSED IMPROVEMENT LOCATION:
Address: 9509 S Indian River Dr, Fort Pierce FL 34982
Property Tax ID #: 3519-444-0002-000-0
Site Plan Name: Allen Residence
Project Name: Allen Residence
DETAILED DESCRIPTION OF WORK:
Construction of in ground residential pool, s
Lot No.
Block No.
CONSTRUCTION INFORMATION: -
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters -Windows/Doors
_ Electric ✓ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 3,,S 066 W Utilities: -Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Brett and Jennifer Allen
Name: Frank Juliano
Address: 9609 S Indian River Dr
Company: Pool Tek of the Palm Beaches
City: Fort Pierce FL State: _
Zip Code: 34982 Fax:
Phone No.
Address: 990 Stinson Way, Suite 213
City: West Palm Beach State: FL
Zip Code: 33411 Fax:
Phone No 561-514-1514
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail office@pooltekofpb.com
State or County License CPC 1457104
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
e f-
SUPPLEMENTAL CONSTR61ETION
LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:--
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
I&
Signature OwnContractor as Agent for Owner
Holder
STATE OF FLORIDASTATE OF FLORI COUNTY OF Ir1 ,�f <.� COUNTY OF �i✓1 r m61
The for gqang instr t was acknowledged before me
this1"day of 20,2�)by
OR Produced Identification
The fo�ing instrument was acknowledged before me
this Lday of20;�O by
>�✓Gh�' �ul�Gh �
Name of pacs n making statement.
I/ OR Produced Identification
RENEE C WELLS
LGc RENEE C WELLS
(Signature of Notary o IPfiSSldr)N GG 207862 Signature of Notary P "o `7(f8F dgi�p"Stue et Florida
"eo, ssoS' My Comm. Expires Apr 16, 2022 ammissl n N GG 207if2
• al Notary Assn, �"�'or M1° My Comm. Expires Apr 16, 2022
W.
Commission No. Banded throng Commission No.�Bonded throuBh(�ijl Notary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW -,REVIEW
REVIEW
REVIEW
REVIEW
DATE
`21�
RECEIVED
1L
DATE
COMPLETED
ftev.2/7/19 - 1 /